![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 3 to 27 of 27. Go back in thread:
Posted by judy1 on October 29, 2002, at 20:22:38
In reply to Fentanyl, posted by Squiggles on October 29, 2002, at 15:30:51
I've taken it (in the patch form) which is really effective for chronic pain. Also the dose is in ug. vs mg for morphine, etc. Take care, judy
Posted by Squiggles on October 29, 2002, at 21:10:08
In reply to Re: Fentanyl » Squiggles, posted by judy1 on October 29, 2002, at 20:22:38
Wow! I hope you are not suffering from
anything serious; so that's micrograms.
Good to know they have these drugs -- i was
looking at warfare chemicals and my head
is spinning--so many chemists, so few
drug doctors;Squiggles
Posted by viridis on October 30, 2002, at 3:54:27
In reply to Fentanyl, posted by Squiggles on October 29, 2002, at 15:30:51
Fentanyl became notorious in the 1980s. There was a mysterious rash of heroin users (some casual) who suddenly came down with Parkinson's disease as early as their teens or twenties. It turned out that some underground chemists had started synthesizing Fentanyl (and related synthetic opiates) and selling them on the street as a sort of "super heroin". Aside from some overdoses, one of the unfortunate side effects was that certain batches were contaminated with an impurity (due to incorrect/sloppy synthesis) that destroyed key brain cells, causing instant and irreversible Parkinsonism.
I believe that at the time Fentanyl (or at least some related compounds, some unknown and actually created by illegal drug manufacturers) weren't yet covered by drug laws, but the DEA etc. soon moved to close this loophole. Another reason to be wary of street drugs.
Posted by turalizz on October 30, 2002, at 4:05:32
In reply to Re: Fentanyl, posted by viridis on October 30, 2002, at 3:54:27
Fentanyl is not MPTP is it?
Posted by judy1 on October 30, 2002, at 5:17:12
In reply to Re: Fentanyl » viridis, posted by turalizz on October 30, 2002, at 4:05:32
What is MPTP? Fentanyl is a very powerful narcotic. BTW, we had some discussions here a while ago, where I was taking it for depression, and despite it's prescribed use for chonic pain, it was the most effective AD I have ever taken- judy
Posted by turalizz on October 30, 2002, at 5:41:56
In reply to Re: Fentanyl » turalizz, posted by judy1 on October 30, 2002, at 5:17:12
> What is MPTP? Fentanyl is a very powerful narcotic. BTW, we had some discussions here a while ago, where I was taking it for depression, and despite it's prescribed use for chonic pain, it was the most effective AD I have ever taken- judy
MPTP is a neurotoxic street drug that selectively kills dopaminergic neurons. As Viridis mentioned about causing parkinsonism, it reminded me of MPTP, but I failed to notice that it was because of incorrect synthesis of that drug. Sorry, my mistake.
cem
Posted by viridis on October 30, 2002, at 6:05:48
In reply to Re: Fentanyl, posted by turalizz on October 30, 2002, at 5:41:56
Slight correction:
MPTP is a neurotoxic contaminant of incorrect meperidine (= demerol, another synthetic opiate) synthesis, not fentanyl. Synthesis of meperidine analogues caused Parkinsonism; fentanyl analogues caused numerous overdose deaths. Both appeared on the street around the same time. There's no reason to worry about prescription versions of either drug (produced with strict quality control), and MPTP is not the same thing as Fentanyl. But if you buy "synthetic heroin" on the street, who knows what you're getting?
Posted by Squiggles on October 30, 2002, at 6:28:29
In reply to Re: Fentanyl, posted by viridis on October 30, 2002, at 3:54:27
So Fentanyl is a street drug; how unfortunate
for the poor users--it sounds a bit like what
happened with cocaine to crack.Squiggles
Posted by meow mary on October 30, 2002, at 10:49:48
In reply to Re: Fentanyl » Squiggles, posted by judy1 on October 29, 2002, at 20:22:38
So you've taken it both for chronic pain and depression? How was Fentanyl prescribed for depression, and wasn't it hard to stop if it was the best thing that ever worked for you? What do you do now for pain? Sorry so many questions, but I have both chronic pain and depression. The only time I ever had Fentanyl was IV before surgery in the hospital.
Posted by judy1 on October 30, 2002, at 16:08:35
In reply to Re:Judy/Fentanyl, posted by meow mary on October 30, 2002, at 10:49:48
We have had many threads on opiate use and depression, Elizabeth was the resident expert- you might want to do a search. Learning that fentanyl was a great AD happened while I was taking it for a herniated disc/ torn acl, etc (car accident). I continued even after the pain was better, and today I take morphine- my shrink knows I take it for depression, but I go to another doc to get it for pain. I have never had to increase my dose (like benzos for panic) and while physically addicted, I am not psychologically addicted and have tapered and stopped at times. I can't recommend lying, but there are actually some pdocs who do understand the connection of opiates (the first AD) and depression. take care, judy
Posted by meow mary on October 30, 2002, at 20:38:29
In reply to Re:Judy/Fentanyl » meow mary, posted by judy1 on October 30, 2002, at 16:08:35
Thanks. I have read some of those posts here--I was wondering if your doctor was actually prescribing the Fentanyl for depression. My doctor did mention bupenorphrine at one point, but is concerned about the legality of it in the US and doesn't have exerience prescribing it other than in injection form for his patients who were being treated for addiction. He said he would research it, but that most people don't want to touch it "with a ten foot pole". I'm amazed that you haven't had to increase your dose because I thought that was the big problem with opiates--developing such a fast tolerance. Anyway, you sound like you have found something good that works for you, and that is great.
Posted by judy1 on October 31, 2002, at 10:58:16
In reply to Re:Judy/Fentanyl, posted by meow mary on October 30, 2002, at 20:38:29
Hi,
Actually my shrink does prescribe vicodin (in 10mg doses/day) for his treatment-resistant anxiety-depression patients. I'm just in a way different class, morphine and fentanyl are schedule 3 narcotics and as such warrent triplicate prescriptions and FDA monitoring- so naturally those type of meds are prescribed only by 'pain' drs aka anesthesiologists. I mentioned my pdoc, and I know other shrinks at UCLA that use opiates in treatment. hope you feel better, and if you have documented pain- then expect the need for increased dose but with depression it doesn't seem to have that effect. take care, judy
Posted by meow mary on October 31, 2002, at 13:02:46
In reply to Re:Judy/Fentanyl » meow mary, posted by judy1 on October 31, 2002, at 10:58:16
Hi. I'm wondering if there's a way for me to get those names....? Thanks.
Posted by judy1 on October 31, 2002, at 18:18:11
In reply to Re:Judy/Fentanyl, posted by meow mary on October 31, 2002, at 13:02:46
are you in southern california? if so, try the dept of psychiatry at UCLA and ask who's using alternative treatments for depression, i'm uncomfortable posting my shrink's name here. take care- judy
Posted by judy1 on October 31, 2002, at 18:22:50
In reply to Re:Judy/Fentanyl » meow mary, posted by judy1 on October 31, 2002, at 18:18:11
Who treats your chronic pain?- there are centers and pain doctors that just write scripts for narcotics. if you are in chronic pain, then you should be properly treated for that and as a bonus your depression will be treated.- judy
(the 2 pain drs i've seen both said their patients often had depression comorbid with the pain)
Posted by meow mary on October 31, 2002, at 21:20:42
In reply to p.s. to Mary, posted by judy1 on October 31, 2002, at 18:22:50
My doctor will prescribe Vicodin for both depression and pain, but doesn't want to increase the dose and it doesn't do anything for me anymore. That was an alternative to the bupenorphrine, which he first suggested and then backpedaled about. Now he said he would research it again, but when we last talked he made the comment about no-one wanting to get near it.
Posted by judy1 on November 1, 2002, at 9:26:34
In reply to Re: p.s. to Mary, posted by meow mary on October 31, 2002, at 21:20:42
I don't remember if anyone had success with bupe (i did not), but is your doc just a plain GP/internist/shrink? I ask because there is a completely different mindset with pain drs., they understand that pain requires increasing doses of narcotics (I can't believe your doc doesn't get that, it's probably just fear), and will prescribe accordingly. I don't know if your insurance will cover a trip to a pain clinic, i landed up paying out of pocket- but it was the best money i ever spent (and a whole lot cheaper (and legal) rather than going on-line and ordering, which i've done also) let me know whether there is a pain clinic in your town, and if you go i'll post pointers. good luck, judy
Posted by oracle on November 1, 2002, at 11:58:37
In reply to Re: Fentanyl » viridis, posted by Squiggles on October 30, 2002, at 6:28:29
> So Fentanyl is a street drug; how unfortunate
> for the poor users--No, Fentanyl is perscribed, called china white on street
Posted by meow mary on November 1, 2002, at 12:07:20
In reply to Re: p.s. to Mary » meow mary, posted by judy1 on November 1, 2002, at 9:26:34
Thanks so much for the info. Yes, my doctor is a psychiatrist. (Even so, you'd think he'd understand...) Do you mind telling me about your bupe experience? (sorry if you've posted it before.) Thanks again.
Posted by meow mary on November 1, 2002, at 13:02:22
In reply to Re: p.s. to Mary, posted by meow mary on November 1, 2002, at 12:07:20
Come to think of it I do think my doctor has some experience treating chronic pain. At one point he prescribed Ultram, saying his patients with chronic pain switch back and forth between Vicodin and Ultram so they don't develop a tolerance to either. Unfortunately the Ultram made me feel really uncomfortable. Maybe I should also mention that I have a tenacious, treatment resistant uni-polar depression that we've been trying to treat for years. For some reason he's ok with a certain amount of Vicodin as part of the treatment (the only thing that helped for awhile), but has fear of doing anything else as a "mainstay". Thanks for listening.
Posted by judy1 on November 2, 2002, at 9:31:02
In reply to P.S To Judy, posted by meow mary on November 1, 2002, at 13:02:22
it just makes me angry that your dr. thinks you may develop a tolerance to vicodin, when look at the poor guy posting below trying to get off of zyprexa- some psychotropic meds are just as bad or worse than narcotics when discontinuing. I probably sound like a broken record, but a pain dr. understands the tolerance issue and will raise the dose of the med for pain (and I'm hoping once that's under control, you will feel less depressed). Bupe and ultram did not help my pain or mood, both unsettled my stomach. BTW, vicodin is about middle in the narcotic strength range- I would not be surprised at all to see a pain dr prescribe something more potent, especially at higher doses since vicodin has so much APAP in it- I think 5/500, at least Norco is 10/250?- and it's the other stuff that screws up your liver, not the hydrocodone. Take care, judy
Posted by meow mary on November 2, 2002, at 12:19:09
In reply to That is just so bogus » meow mary, posted by judy1 on November 2, 2002, at 9:31:02
...acetominophen?
Posted by viridis on November 2, 2002, at 13:03:28
In reply to APAP..., posted by meow mary on November 2, 2002, at 12:19:09
As I understand it, acetominophen (Tylenol) is the problem ingredient in Vicodin -- it's hard on the liver at high doses. You can also get Vicoprophen (hydrocodone plus ibuprophen), but many doctors are less familiar with it. I think ibuprophen is considered safer, although I'm not sure what health risks it may have. There are also hydrocodone/aspirin mixes (e.g., Empirin), although the aspirin carries the risk of stomach bleeding with regular use.
Posted by ShelliR on November 6, 2002, at 19:40:50
In reply to Re: p.s. to Mary, posted by meow mary on October 31, 2002, at 21:20:42
> My doctor will prescribe Vicodin for both depression and pain, but doesn't want to increase the dose and it doesn't do anything for me anymore. That was an alternative to the bupenorphrine, which he first suggested and then backpedaled about. Now he said he would research it again, but when we last talked he made the comment about no-one wanting to get near it.
Hi Mary,
I tried Vicodin successfully for depression then was switched to oxycontin so it would have a longer effect. Within six months, I had to increase to a huge dose to get any effect against the depression. It was a bit scary and very very expensive (no prescription drug coverage).
I have switched to methadone; it's advantage is that it is much much cheaper than oxycontin. I am given it by a pain doctor, much like any other opiate.
If you do a search on buprenorphine, you'll find a lot of info from Elizabeth who was able to take small amounts successfully for a long time. But in the US it is only available in liquid, IV form, so she was having to inhale the liquid several times a day through her nose. Plus, it was only an adjunct to her main AD--effexor.
It was supposed to come out this year in sublingual form, but they've put it on hold for at least a year. I tried it (from overseas) and really liked it for helping the depression, but started building up a tolerance to that quickly also. And then it became very difficult to find access to.
The worst part about being on an opiate was that several times when I had to go into the hospital this last year for severe depression, the staff (doctors and nurses) treated me like a street addict and it was a horrible horrible experience which I would do anything not to repeat. If there's anything else that would work, I'd stay away from opiates, unless you have a very supportive doctor who will not abandon the effort if you have to go up. That's usually part of opiate treatment. For a positive, I never found opiates very difficult to get off of; I've done it in one day, but when I gave it a week, there was almost no discomfort.
Shelli
Posted by meow mary on November 6, 2002, at 22:53:19
In reply to Re: p.s. to Mary » meow mary, posted by ShelliR on November 6, 2002, at 19:40:50
Thank you so much for your response. I saw my doctor yesterday. He has prescribed me Oxycodone in the last couple of weeks (in addition to trying to adjust to Lexapro which is not going well) to get through some particularly hard times. He can prescribe it for pain only, which I do have, but understands it is also for depression. However, he says it is too much of a problem to stay with long term, as you have illustrated. Now I'm really worried, because I know I'll have to go off of it, and I think he's nervous about the whole thing as well, which makes me more nervous. He says I'll have to accept the loss of something that is working for me. Ironically, it doesn't work wonders, it just brings me from not getting out of bed to less depressed. I'm trying to stay at a low dosage, but I feel so conflicted about the whole thing. I can't take enough to feel good, and I already feel like I shouldn't be doing it at all. I told him yesterday the whole situation makes me feel like a criminal. I would never have considered this had I not tried almost every other medication available with negligable success and intolerable side effects. My doctor is pretty open considering what I've read, but he is still afraid, and not without reason I guess. Yesterday he said we're dealing with an attorney general who covered Greek statues because they were naked. He says he'll prescribe Bupenorphrine when (if )it does become legal in other than injectable form, but now I'm wary about the tolerance developing from that as well. I do not find coming off the opiates to be easy because of preexisting pain, but I'm glad to hear you say it wasn't hard for you-- even the oxycodone? And you're doing well with the Methadone? The whole thing is really scary. Thanks again.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.